Healthcare Provider Details

I. General information

NPI: 1861702383
Provider Name (Legal Business Name): WAYNE GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR SUITE A
WAYNESBORO MS
39367-2565
US

IV. Provider business mailing address

951 MATTHEW DR SUITE A
WAYNESBORO MS
39367-2565
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY WADDELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 601-735-7100